Biomedical subjects
Publications and source records attributed to S V Tsarenko.
An original method of impedancemetry designed by the authors and applied in 88 cases of cerebral edema caused by brain aneurysm rupture (n = 23), by acute hemorragic stroke of hypertensive type (n = 13) and craniocerebral injury (n = 52) is described. Diagnostic value of the method, its safety and convenience for clinical practice are demonstrated.
Acute erosive lesions of upper parts of gastrointestinal tract with bleeding aggravate severe burn trauma, postoperative period after extensive surgeries and is the often component of polyorganic insufficiency syndrome. Gastric secretion in patients with severe burn trauma and neurotrauma was studied. Decrease of gastric secretory function due to central paresis of gastrointestinal tract and reflux of bile into stomach was seen in majority of patients with neurotrauma and acute gastric ulcers. On the contrary, in patients with burn shock increase of acid-secretory function of stomach was revealed. Schemes of prophylaxis and treatment of acute ulcers were developed. They included antacid therapy (for patients with increased secretion), regulators of motor-evacuatory function of stomach and intestine (for patients with paresis), drugs increased regenerative properties of mucosa, early enteral nutrition with balanced mixtures. This treatment in combination with hemostatic therapy and cure of main disease permitted to reduce number of gastroduodenal bleedings and lethality in these patients.
A success in treatment of acute ulcerations of the upper parts of the gastrointestinal tract in patients with a severe neurosurgical pathology can be achieved only with a complex approach to treatment of the intensive care patients. The application of antiulcerous medicines in combination with pyrokinetics and medicines improving the regeneratory ability of the gastrointestinal tract mucosa allowed to considerably decrease risk of the development of gastroduodenal bleedings against the background of erosive-ulcerous lesion of the mucosa. The endoscopic methods of arresting bleedings in such patients in combination with the correction of homeostasis by infusions and local hemostatic therapy in most cases result in reliable hemostasis of the upper parts of the gastrointestinal tract. The program of active measures is completed with the early enteral feeding with balanced nutritional mixtures.
The assessment of ECG in patients with nontraumatic subarachnoid hemorrhages demonstrated 5 characteristic patterns of ECG change. They were shown to be secondary to cerebral pathology. Preoperative heart rhythm changes are not stable or life-threatening, whereas intraoperative arrhythmias, high-grade ventricular extrasystoles in particular, may prove fatal. Preoperative ECG changes, including "pseudoinfarction" ones, do not affect cardiac output or arterial blood pressure, so that no special treatment is required, nor is surgery contraindicated.
With ECG of the patients with arterial brain aneurysms ruptures analyzed in the pre- and postsurgical periods, 5 characteristic types of changes could be identified. Functional (secondary) nature of ECG changes was established and their dependence on the severity of the patients' state, aneurysm localization, disease duration, presence of angiospasm and intracranial hematoma were evidenced. The increase in the markedness of ECG disorders did not correspond to hemodynamic impairment. ECG changes are no contraindications for urgent surgery of the aneurysm. Nevertheless, distinct ECG changes were noted which could serve as prognostic criteria for the fatal outcome of the surgery.
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Based on the international and Russian guidelines, the paper describes standards, recommendations and options developed on the principles of evidence-based medicine for severe brain injury. It also presents a spectrum of recognition, management, and differential treatment of victims with severe brain and skull injury.
Study of the ECG and central hemodynamics and the results of mathematical analysis of the heart rhythm in patients with rupture of arterial aneurysms in the pre- and postoperative period showed that the values of cardiovascular activity are prognostic signs of the outcome of surgical and nonoperative treatment. Postponement of operation on patients with arterial hypertension for 1-3 days from the onset of the disease may be fatal. Correction of increased systolic pressure and high cardiac output after the operation is inadmissible because they are favourable responses of the organism to the operative trauma. Moderate activation of the sympathetic and parasympathetic nervous system on the eve of the operation has a favourable effect on its outcome.
The potentialities of cerebral oximetry in the para-infrared band as a means of neuromonitoring are assessed. The method is highly informative for selecting the treatment strategy during the acute period of craniocerebral injury and cerebrovascular diseases. Simultaneous analysis of intracranial pressure, central hemodynamics, and cerebral oximetry permits differentiation of mechanisms of intracranial hypertension and its compensation. Increase of rSO2 in increased intracranial pressure corresponds to brain hyperemia, its decrease to cerebral ischemia. A long trend of rSO2 changes is informative for disease prediction.